Ravi Gupta

Comorbid depression in obstructive sleep apnea: an under-recognized association.

BackgroundObstructive sleep apnea (OSA) and depression may coexist in the same patient. This article aims to review the link between OSA and comorbid depression and critically evaluate the results of studies that assessed the correlation between OSA and depression, the impact of OSA treatment on comorbid depression, and the impact of comorbid depression on continuous positive airway pressure (CPAP) adherence.MethodsAn integrative review was conducted on English language studies and reports that assessed the relationship between OSA and depression. Studies were identified by searching PubMed, Web of Science and Google Scholar databases, and reference lists of included studies.ResultsGenerally, cross-sectional studies show a higher prevalence of depression among OSA patients with both community and sleep disorder clinic samples. Nevertheless, the relationship between OSA and depression is complicated by the fact that the disorders have overlapping symptoms. Longitudinal studies demonstrate an increased risk of developing depression among people with OSA, as well as an association between OSA severity and the likelihood of developing depression. On the other hand, studies assessing the impact of CPAP therapy on depression among OSA patients report conflicting results. Therefore, it is essential to consider how the disorders affect one another and to understand the clinical consequences of treating each disorder in isolation.ConclusionDepression is prevalent among patients with OSA both in the community and in sleep disorder clinics. Clinicians in general should be aware of this significant association and should aim to treat both disorders.

Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment.

Restless legs syndrome (RLS) is a common sleep disorder that may be associated with pregnancy. Studies have found that the prevalence of RLS among pregnant women ranged from 10 to 34%. Typically, there is complete remission of symptoms soon after parturition; however, in some patients, they may continue postpartum. RLS has been shown to be associated with a number of complications in pregnancy including preeclampsia and increased incidence of Cesarean sections. Although multiple hypotheses have been proposed to explain this association, each individual hypothesis cannot completely explain the whole pathogenesis. Present understanding suggests that a strong family history, low serum iron and ferritin level, and high estrogen level during pregnancy might play important roles. Vitamin D deficiency and calcium metabolism may also play a role. Medical treatment of RLS during pregnancy is difficult and challenging considering the risks to mother and fetus. However, in some cases, the disease may be severe enough to require treatment.

Sleep Disorders in Postmenopausal Women.

One of the core symptoms of the menopausal transition is sleep disturbance. Peri-menopausal women often complain of difficulties initiating and/or maintaining sleep with frequent nocturnal and early morning awakenings. Factors that may play a role in this type of insomnia include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle. Other common sleep problems in this age group, such as obstructive sleep apnea and restless leg syndrome, can also worsen the sleep quality. Exogenous melatonin use reportedly induces drowsiness and sleep and may ameliorate sleep disturbances, including the nocturnal awakenings associated with old age and the menopausal transition. Recently, more potent melatonin analogs (selective melatonin-1 (MT1) and melatonin-2 (MT2) receptor agonists) with prolonged effects and slow-release melatonin preparations have been developed. They were found effective in increasing total sleep time and sleep efficiency as well as in reducing sleep latency in insomnia patients. The purpose of this review is to give an overview on the changes in hormonal status to sleep problems among menopausal and postmenopausal women.

Erlotinib-induced cutaneous toxicity: findings on 18F-FDG PET/CT imaging.

Erlotinib is a reversible epidermal growth factor receptor tyrosine kinase inhibitor used to treat advanced non-small cell lung carcinoma patients who have shown progression on at least 1 prior chemotherapy regimen. Most of the patients on erlotinib show cutaneous adverse effects. We report the 18F-FDG PET/CT findings in a case of metastatic non-small cell lung carcinoma on erlotinib chemotherapy with developed skin toxicity.

Disseminated histoplasmosis demonstrated on F18-fluorodeoxyglucose positron emission tomography/computed tomography in a renal transplant recipient.

1. Yildiz AE, Ariyurek MO, Karcaaltincaba M. Splenic anomalies of shape, size, and location: Pictorial essay. Scientific World Journal 2013;2013:321810. 2. Mortelé KJ, Mortelé B, Silverman SG. CT features of the accessory spleen. AJR Am J Roentgenol 2004;183:1653-7. 3. Lebtahi R, Cadiot G, Marmuse JP, Vissuzaine C, Petegnief Y, Courillon-Mallet A, et al. False-positive somatostatin receptor scintigraphy due to an accessory spleen. J Nucl Med 1997;38:1979-81. 4. Martínez-Rodríguez I, Allende RH, Banzo I, Quirce R, Jiménez-Bonilla J, Sainz-Esteban A, et al. Tc-99m red blood cell uptake in positive somatostatin receptor scintigraphy by two accessory spleens. Clin Nucl Med 2006;31:340-1. 5. Sels JP, Wouters RM, Lamers R, Wolffenbuttel BH. Pitfall of the accessory spleen. Neth J Med 2000;56:153-8. 6. Ekmekçi S, Diz-Küçükkaya R, Türkmen C, Adalet I. Selective spleen scintigraphy in the evaluation of accessory spleen/splenosis in splenectomized/nonsplenectomized patients and the contribution of SPECT imaging. Mol Imaging Radionucl Ther 2015;24:1-7. 7. 7. Barber TW, Dixon A, Smith M, Yap KS, Kalff V. Ga-68 octreotate PET/CT and Tc-99m heat-denatured red blood cell SPECT/CT imaging of an intrapancreatic accessory spleen. J Med Imaging Radiat Oncol 2015; doi: 10.1111/1754-9485.12319. [Epub ahead of print]. 8. Collarino A, del Ciello A, Perotti G, Rufini V. Intrapancreatic accessory spleen detected by 68Ga DOTANOC PET/CT and 99mTc-colloid SPECT/CT scintigraphy. Clin Nucl Med 2015;40:415-8.

Choosing the Proper Interface for Positive Airway Pressure Therapy in Subjects With Acute Respiratory Failure

Noninvasive ventilation is an effective treatment for a significant proportion of patients with acute respiratory failure. The success of noninvasive ventilation, however, depends on several factors, a major one being the selection of the proper interface. The choice and application of the interface in patients with acute respiratory failure is a considerable challenge for any treatment team. This review discusses the different types of interfaces that can be used in patients with acute respiratory failure, the differences between nasal, oro-nasal, and total face masks and the helmet, as well as the effect of interface type on treatment success and upper airway patency, mask fitting, problems related to the interface, and the relationship between ventilator type and interface choice.

Asymmetrical F-18 Flurorodeoxyglucose uptake in the breasts: A dilemma solved by patient history

The present case highlights the importance of history taking in solving the dilemmas of variant F-18 FDG uptake on PET/CT. Asymmetrically increased, abnormal looking, FDG uptake in the right breast of our patient was related to her breast feeding practice. Because of personal preference the patient suckled her child from the right breast only. This resulted in asymmetry of size, increase in glandular breast parenchyma and FDG uptake in the breast that was suckled.